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Pharmacology - Final Exam > Diabetes > Flashcards

Diabetes Flashcards

(117 cards)

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1
Q

What is the cause of type 1 DM?

A
  • absolute deficiency of insulin secretion*

- autoimmune destruction of beta cells d/t viruses

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2
Q

What is the cause of type 2 DM?

A

combination of:

  • insulin resistance
  • decline in beta cell secretion of insulin
  • increase of glucose levels regardless of stimuli
  • other hormonal deficiencies
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3
Q

What are the S&S of hyperglycemia?

A
  • 3 P’s (polyuria, polydipsia, polyphagia)

- fatigue

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4
Q

define polyuria

A
  • frequent urination
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5
Q

define polydipsia

A
  • inability to quench thirst
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6
Q

define polyphagia

A
  • loosing weight while eating a lot
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7
Q

What are the main risk factors of DM type 2?

A
  • overweight/obese

- sedentary lifestyle

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8
Q

How often can you test HbA1C?

A
  • q3mo
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9
Q

What are the tx goals for type 2 DM?

A
  • A1C less than 7
  • before meals 70-130mg/dL
  • after meals less than 180mg/dL
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10
Q

What patient population are the tx goals more strict for?

A
  • young
  • active
  • motivated
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11
Q

What is the tx for pre-diabetes?

A
  • metformin
  • diet
  • exercise
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12
Q

What are the microvascular complications of diabetes?

A
  • retinopathy
  • neuropathy
  • nephropathy
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13
Q

What are the macrovascular complications of diabetes?

A
  • CAD
  • HTN
  • dyslipidemia
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14
Q

How is CAD, as a complication of DM, tx’d?

A
  • ASA 81mg/d (baby aspirin)
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15
Q

What is the goal for HTN in DM?

A
  • 140/90
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16
Q

What is the tx for dyslipidemia 2ndary to DM?

A
  • statin
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17
Q

How are retinopathy & neuropathy, as complications of DM, tx’d?

A
  • manage HTN & glucose
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18
Q

What is the tx for peripheral diabetic neuropathy?

A
  • Gabapentin
  • Lyrica
  • Cymbalta
    (all are symptomatic tx, not DM txs)
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19
Q

What is the tx for autonomic diabetic neuropathy?

A
  • Reglan
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20
Q

What is the tx for diabetic nephropathy?

A
  • ACE-I or ARB

- manage HTN & glucose

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21
Q

What is the tx protocol for DM?

A
  1. metformin
  2. ADD sulfonylurea, TZD, DPP4 inhib, GLP1 ag, OR basal insulin
  3. ADD another 1 of the above
  4. ADD multiple doses of insulin
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22
Q

What are the oral diabetic agents?

A
  • biguanides
  • sulfonylureas
  • meglitinides
  • TZD
  • alpha glucosidase inhibitors
  • incretin mimetics (DPP4 inhib, GLP1 ag)
  • sodium glucose co-transporter (SGLT)
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23
Q

What is an example of biguanides?

A
  • Glucophage, Riomet, Glumetza (metformin)
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24
Q

What is metformin’s MOA?

A
  • inhibits hepatic glucose production

- increases insulin sensitivity to peripheral tissues

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25
What is metformin's place in therapy?
- 1st line tx of DM
26
What is metformin's A1C% reduction?
- >2%
27
What is the dose of metformin?
- 1000mg BID
28
What are the side effects of metformin?
- GI (diarrhea) so take with meals - lactic acidosis - Vit B12 deficiency after tx for 2-3yrs - wt loss
29
What is an absolute CI of metformin?
- creatinine levels (>1.4w, >1.5m)
30
What is an example of sulfonylureas?
2nd gen - Amaryl (glimepiride) - Glucotrol (glipizide) - Micronase (glyburide)
31
What is the MOA of sulfonylureas?
- increases insulin production from pancreatic beta cells
32
How are sulfonylureas used in DM therapy?
- monotherapy OR - conjunction with basal insulin or other oral agents
33
T/F: Over time, patients on sulfonylureas & meglitindes will loose beta cel function and become DM type I.
- True, after ~3-5y
34
What is the A1C % reduction of sulfonylureas?
- 1-2%
35
Patient has renal insufficiency, what sulfonylurea will you use?
- glipizide | no Renal, no R
36
What are the side effects of sulfonylureas?
- hypoglycemia | - wt gain
37
What is a precaution for sulfonylureas?
- sulfa allergy
38
What are examples of meglitinides?
- Starlix (nateglinide) | - Prandin (repaglinide)
39
What is the MOA of meglitinides?
- increases insulin production from pancreatic beta cells | similar to sulfonylureas
40
What is the use of meglitinides in therapy?
- monotherapy OR - conjunction with oral agents (similar to sulfonylureas
41
What is the A1C% reduction or meglitinides?
- 0.5-2%
42
T/F: Meglitinides have a longer half life than sulfonylureas?
- false
43
What are the benefits of meglitinides?
- side effects = less hypoglycemia & less wt gain than sulfonylureas - works closer to the meal
44
What are examples of TZDs?
- Avandia (rosiglitizone) | - Actos (pioglitizone)
45
What is the MOA of TZDs?
- potent peroxisome proliferator-activated receptor-gamma (PPAR) agonist - increases insulin-dependent glucose disposal & decreases hepatic glucose output by decreasing insulin resistance in the periphery and liver
46
What is the use of TZDs in therapy?
- monotherapy OR - conjunction with other oral agents or insulin
47
What is a TZDs A1C% reduction?
- 0.5-1%
48
What are the side effects of TZDs?
- MAJOR DROWSINESS - wt gain - edema - increased ovulation - hepatic dysfxn
49
What is a contraindication of TZD?
- stage 3 or 4 heart failure (increases edema, side effect)
50
What are precautions of TZDs?
- active liver disease with ALT >2.5x normal | - monitor LFTs
51
What are examples of alpha glucosidase inhibitors?
- Glyset (miglitol) | - Precose (acarbose)
52
What is the MOA of alpha glucosidase inhibitors?
- inhibits the enzyme that hydrolyzes complex carbs
53
What is the place of alpha glucosidase inhibitors in therapy?
- monotherapy OR - conjunction with other oral agents (especially high postprandial glucose values)
54
What is the A1C% reduction of alpha glucosidase inhibitors?
- 0.5-1%
55
What are the SE of alpha glucosidase inhibitors?
- GI!!! (flatulence, diarrhea) | - tx hypoglycemia with simple sugars
56
What are examples of DPP4 inhibitors?
- Januvia (sitagliptin) - Onglyza (saxaglibtin) - Tradjenta (linagliptin) - Nesina (alogliptin)
57
What is the MOA of DPP4 inhibitors?
- block DPP4 | stops inactivation of GLP1 which allows lowering of blood glucose
58
What is DPP4's normal action?
- inactivates GLP1, prevents lowering of blood glucose
59
What is DPP4 inhibitors place in therapy?
- type 2 DM | - in addition with other oral agents
60
What is the A1C% reduction of DPP4 inhibitors?
-0.4-0.85%
61
T/F: All DPP4 inhibitors need renal dose adjustments.
- False, all EXCEPT LINAGLIPTIN
62
What are the SE of DPP4 inhibitors?
- H/A - URI - wt loss/neutral
63
What are examples of GLP1 analogs?
- Byetta (exenatide) - Victoza (liraglutide) - Tanzeum (albiglutide) - Trulicity (dulaglutide)
64
What is the MOA of GLP1 analogs?
- just different enough that DPP4 cannot break it down
65
What is the use of GLP1 analogs in therapy?
- 2nd line behind metformin | - good for patients that need to loose wt
66
What is the A1C% reduction of GLP1 analogs?
- 1-1.6%
67
Which GLP1s need and do not need renal dose adjustments?
- liraglutide = not studied - exenatide = needs renal dose adjustment - albiglutide, dulaglutide = does not need renal dose adjustment
68
What are the SE of GLP1 analogs?
- feeling full, nauseas, bloated - no hypoglycemia - wt loss
69
What are the black box warnings for GLP1 analogs?
- thyroid CA | - pancreatitis
70
What are the examples of SGLTs?
- *Invokana (canagliflozin)* - Farxigan (dapagliflozin) - Jardiance (empagliflozin)
71
What is the A1C% reduction of SGLT?
- 1%
72
T/F: SGLTs require renal dose adjustments
- true
73
What are the SEs of SGLTs?
- *wt loss* - *modestly lowers BP* - polyuria - thirst - nasopharengitis - UTIs - genital infx
74
Describe insulin
- regulator of glucose metabolism - released from pancreatic beta cells in response to hyperglycemia - inhibits hepatic glucose production - facilitates glucose transport into cells - stimulates glucose storage
75
What are the two categories of insulin on the market?
- prandial (with meals) | - basal (continued longer acting insulin)
76
What are the rapid acting insulins?
no LAG time - Humalog (lispro) - Novolog (aspart) - Apidra (glulisine)
77
What are the long acting insulins?
- Lantus (glargine) | - Levamir (dentimir)
78
What type of insulin is used as bolus?
- rapid & short
79
What type of insulin is used as basal?
- intermediate & long
80
What are the pros of rapid acting insulin?
- better glucose control - less frequent hypoglycemia - convenient (can injx postprandial)
81
What are the pros of short acting insulin?
- no Rx needed - inexpensive - can tx DKA - provides some basal activity
82
What are the cons of rapid acting insulin?
- $$$$$ | - given prior to high fat meal, increases risk of early post-prandial hypoglycemia
83
What are the cons of short acting insulin?
- absorbed too slowly - injx 30-45min prior to eating - prolonged duration of action = late postprandial hypoglycemia
84
Discuss NPH
- causes peaks therefore must eat consistently | - can be mixed with other insulins to decrease # of injxs
85
Discuss glargine
- most used - no peak = less hypoglycemia - CANNOT be mixed with other insulins
86
Compare duration of action of detemir with NPH and glargine
- longer than NPH but shorter than glargine
87
Who should be on combination insulin injections?
- noncompliant pts | - pts that have fixed dosing schedules
88
What is U-500?
- 5x strength of all other insulins
89
Who should use U-500?
- type II DM whose total daily dose of insulin > 200units
90
What is the inhaled insulin?
- Afrezza (rapid acting)
91
What is the CI of inhaled insulin?
- pts w/ chronic lung dz or smoker in last 6mo
92
When is inhaled insulin dosed?
- beginning of meal
93
What is the starting dose of insulin for DM type 1?
- (0.3 to) 0.5 units/kg/d - divide dose by 2 to determine prandial & basal doses - tirate PRN
94
Discuss insulin schedule for type 2 DM
- consider when HbA1c >8% | - start with basal, titrate, add prandial PRN
95
What is the starting dose of insulin for DM type 2?
- 10 units intermediate/long | - increase by 1 unit per day until preprandial goal = 80-130mg/dL
96
What is the dose of starting prandial insulin for type 2 DM?
- 4 units w/ largest meal & add insulin to other 2 meals PRN
97
What is the 1700 Rule?
- general starting point for someone new to insulin | - 1 unit for every 50 units above goal
98
What is the calculation for the 1700 Rule?
- (1700/total daily dose) = amt of glucose that will be reduced by 1 unit of insulin - 1 unit of insulin will lower the glucose level by (1700/total daily dose)
99
What is the 450 Rule?
- (450/total daily dose) = grams CHO covered by 1 unit insulin - 1 unit of insulin will cover (450/total daily dose) grams of CHO
100
If the patient is on insulin, they should still be on ______ unless ????
- metformin | - metformin was contraindicated or not tolerated
101
If a pt is taking _____ they can continue this while on _____ _____ howerver, ?????
- sulfonylurea - basal insulin - it might be stopped if prandial insulin is started
102
Why would a patient on only basal insulin also be given GLP1s?
- especially if they need to loose weight
103
What else can be added to insulin regimen?-
- DPP4 inhibitor | - SGLTs
104
Why might a type 2 DM require higher doses of insulin than a type 1?
- insulin resistance
105
What is the tx for Somogi effect?
- reduce night insulin
106
What is the Somogyi effect?
- early am hypoglycemia followed by rebound hyperglycemia
107
What is the Dawn phenomenon?
- relative resistance to insulin in early am
108
What are diabetics supposed to do on sick days?
- continue insulin | - may require more since body is so stressed
109
How is hypoglycemia tx'd?
- Rule of 15
110
What is the Rule of 15?
- 15g sugar will raise your blood sugar by 15 points in 15 mins
111
What are the side effects of insulin?
- hypoglycemia - wt gain - injx site rxns
112
How do you store insulin?
- refrigerate unopened pens or vials | - room temp opened pens or vials
113
How do you mix insulin?
- clear before cloudy
114
What insulin cannot be mixed with anything?
- glargine
115
Diagnostic criteria of HbA1C
- normal: less than 5.7 - prediabetes: 5.7-6.4 - diabetes: over 6.5
116
Diagnostic criteria of FPG
- normal: less than 100mg/dL - prediabetes: 100-125mg/dL - diabetes: over 126mg/dL
117
Diagnostic criteria of OGTT
- normal: less than 140mg/dL - prediabetes: 140-199mg/dL - diabetes: over 200mg/dL

Pharmacology - Final Exam (4 decks)

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